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Methods of Documentation V: CBE01:23

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Charting by Exception, or CBE, is a method of documentation used in healthcare, particularly in nursing, that focuses on documenting only significant or abnormal findings rather than recording every detail. This approach aims to streamline the documentation process, improve efficiency, and ensure that healthcare providers can quickly identify deviations from normalcy in patient assessments.
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Feedback in an Entrustment-Based Objective Structured Clinical Examination: Analysis of Content and Scoring Methods.

Isabelle Nguyen-Tri1, Dave Tremblay-Laroche1, Félix Lavigne2

  • 1is Associate Professor, Department of Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.

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Examiners provided high-quality, aligned feedback during entrustment-based Objective Structured Clinical Examinations (OSCEs). Scoring methods did not significantly impact feedback quality or alignment with learning objectives.

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Area of Science:

  • Medical Education
  • Clinical Assessment
  • Healthcare Professional Development

Background:

  • Integrating Entrustable Professional Activities (EPAs) into Objective Structured Clinical Examinations (OSCEs) offers timely feedback for residents.
  • Concerns regarding the quality of feedback in these assessments persist.
  • This study addresses the need to evaluate feedback effectiveness in an entrustment-based OSCE context.

Purpose of the Study:

  • To assess the quality and content alignment of verbal feedback from examiners during an entrustment-based OSCE.
  • To compare the impact of different scoring methods on feedback quality and alignment with learning objectives.

Main Methods:

  • A progress test OSCE for internal medicine residents assessed 7 EPAs.
  • Examiner feedback (2-minute duration) was recorded and analyzed using the Quality of Assessment of Learning (QuAL) score.
  • Feedback alignment with EPA learning objectives (competency milestones, task-specific abilities) was evaluated.
  • A randomized crossover experiment compared 3-point entrustability scales versus task-specific checklists for scoring.

Main Results:

  • Twenty-one examiners provided feedback to 67 residents.
  • Feedback quality was high (mean QuAL score 4.3/5) and aligned with EPA learning objectives.
  • Examiners addressed an average of 2.5 milestones (61%) and 1.2 task-specific abilities (46%).
  • Scoring methods showed no significant impact on QuAL scores or alignment with milestones/abilities (P > .13).

Conclusions:

  • Examiners provided valuable, high-quality feedback aligned with learning outcomes in the entrustment-based OSCE.
  • Feedback quality and alignment were explored as distinct dimensions.
  • The scoring methods evaluated did not significantly influence feedback quality or its alignment with learning objectives.